Southern Minnesota Periodontics, Pa
LBN: Southern Minnesota Periodontics, Pa
Southern Minnesota Periodontics, Pa is an health care organization with primary practice located at 99 Navaho Ave Suite 102, Mankato MN 56001-4876. The organization recently has only one registered license in Dental Providers / Periodontics, which is considered as the primary health care specialty.
Southern Minnesota Periodontics, Pa can be contacted via phone (507) 345-7537, or through Jernberg, Gary via phone (507) 345-7537.
Contact Information
Primary practice address
99 Navaho Ave Suite 102
Mankato MN 56001-4876
Phone: (507) 345-7537
Fax: (507) 345-7538
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Periodontics | 1223P0300X | 8671 | Minnesota |
| Dental Providers / Periodontics | 1223P0300X | 11710 | Minnesota |
Profile Details
| NPI number | 1609012624 |
|---|---|
| LBN Legal business name | Southern Minnesota Periodontics, Pa |
| DBA Doing business as | |
| Authorized official | Jernberg, Gary |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Dec 22nd, 2008 |
| Last updated | Dec 22nd, 2008 - about 16 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609012624 | NPPES |
| Pennsylvania | Other | 000839878 | UNITED CONCORDIA |
| Pennsylvania | MEDICAID | 737722300 | UNITED CONCORDIA |
| Pennsylvania | Other | 1B004JE | UNITED CONCORDIA |
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